The BGHEI brings together a diverse group of global health education leaders from high, middle and low income countries to establish the groundwork for a universal curriculum for global health and challenge educators and institutional participants to rethink traditional concepts.

Global health clinical electives provide international clinical experiences that are transformative for medical students across the globe. Despite the popularity and impact of these courses, however, questions remain regarding the student populations for whom these courses are most beneficial and the appropriate ways to assess their learning. In June 2015, experts in global health education gathered at the Bellagio Conference Center to discuss these outstanding questions.

Every faculty member responsible for students participating in global health clinical electives has heard a student say, “That experience changed my life!” However, despite the transformative impact of global health clinical electives on some medical students and the popularity of global health education (GHE) in high-income country medical schools, one can ask: should GHE be part of the curriculum for students in every country, or is it of use only for students from high-income countries who intend to practise outside their own country? Other fundamental questions include: Can global health be learned in the classroom, or does it require an experience in a culturally foreign setting? How can we assess a student who is learning on a distant global health clinical elective under the supervision of a faculty member who may have only a tenuous connection to the student’s home institution?

These key questions motivated our discussions in June, 2015, at the Rockefeller Foundation’s Bellagio Conference Center. 19 GHE faculty, administrators, policy makers, and trainees from ten high-income, low-income, and middle-income countries participated in a conference entitled “Towards a universal medical student curriculum for global health.” A combination of formal debate, brief talks, nominal group process, and group discussion began to answer these questions.

Deliberations were guided by two main principles. First, we aimed to use work that has already been published, including work defining global health competencies, the biosocial approach to managing global health problems, and the epidemiology of global health problems. This was done while recognising, however, that limited input by low- and middle-income countries (LMICs) may limit the universal applicability of some of this work. Second, deliberations aimed to focus on what is unique to GHE that all students need to learn while defining the learning needs of students who are interested in global health careers. For example, all students need to learn principles of cross-cultural medicine to be competent to practise medicine in cross-cultural environments within their own country. However, only students who are especially interested in global health need to learn about evidence-based emerging health priorities for specific global regions.

Five key curricular recommendations resulted from deliberations at the conference. First, we advise that all students will benefit from GHE in their core curriculum. Conference members identified eight GHE themes that all students should learn, including communication, culture, health-care delivery, social determinants of health, burden of disease, ethics in global clinical practice, using clinical skills in a limited-resource environment, and basic management skills. An ‘away’ experience, defined as one in which the student lives in an unfamiliar culture, is preferred but not required. Global health clinical electives are increasingly popular ‘away’ experiences for students from LMICs. There is a growing awareness that global health concepts apply to underserved populations in high-income countries, and a growing appreciation that high-income countries may have less to teach LMICs than to learn from them.

Second, we recommend involvement of students and faculty from both the home and the ‘away’ institution. For example, the LMIC student’s cross-cultural experience at an ‘away’ site may be just as surprising and transformative as a high-income country student’s. For LMIC students, emphasising experience at in-country ‘away’ sites would enable learning academic and affective skills appropriate for low-resource settings while avoiding idealising high-income country technological advances.

Third, we emphasise the uniqueness of the experience at the ‘away’ site. Currently, there is only one medical school we know of that has incorporated a required global health clinical elective into the curriculum. Principles and skills relevant to GHE can be effectively taught in the classroom, but a transformative global health educational experience is facilitated by experience outside a student’s comfort zone.

Fourth, we recommend that the design and implementation of global health clinical elective experiences promote transformative learning. Defined as a change in a student’s understanding of the internal structures used to organise their experience of the world, we believe transformative learning is facilitated in global health clinical elective settings. For example, a US medical student sent a series of emails home to his wife explaining how working in a limited-resource environment in Kenya was similar for him to experiencing grief. In addition, an African student completing an elective in the USA realised that her rich clinical exposure at home had included exposure to teachers who relied more confidently on their clinical skills than did many US clinicians.

Fifth, while evaluation of coursework in global health at a student’s home medical school could involve multiple-choice exams, essays, or problem solving exercises, ‘away’ experiences should emphasise the use of reflective practice skills. These might include reflection papers, journals, and blogs that map a student’s experience and enable formative review with an experienced tutor.

On the last day of the conference, we formed the Bellagio Global Health Education Initiative (BGHEI), which, over 2 years, aims to reframe the discussion about GHE goals, teaching, and assessment methods, and the necessity for all medical students, regardless of their country of origin, to be exposed to the principles and experience of global health.

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